Wagner Eric R, Weston John T, Houdek Matthew T, Luo T David, Moran Steven L, Rizzo Marco
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
J Hand Surg Am. 2018 Sep;43(9):797-805. doi: 10.1016/j.jhsa.2018.06.020.
The purpose of this study was to examine the medium-term outcomes of patients undergoing proximal interphalangeal (PIP) joint arthroplasty using a pyrocarbon implant.
The study comprised an analysis of 170 PIP joint pyrocarbon arthroplasties in 99 patients with a minimum 2-year clinical follow-up. Diagnoses included inflammatory arthritis (n = 49), posttraumatic arthritis (n = 29), and osteoarthritis (n = 92). Univariate logistic regression and Kaplan-Meier survival analyses were performed.
At an average follow-up of 6 years (range, 2-14 years), 58 reoperations (34%) were required, including 36 (21%) involving implant revision surgery. The majority of revisions were performed for either dislocations (n = 16) or pain and stiffness (n = 14). The 5- and 10-year survival-free of revision surgery rates were 79% and 77%, respectively. The risk for revision surgery was higher in patients with posttraumatic arthritis. There were 15 intraoperative complications involving a fracture and 26 postoperative complications, including 21 dislocations. In unrevised implants, patients had significant improvements in their preoperative to postoperative pain levels, with no change in their PIP joint total arc of motion. At a mean radiographic follow-up of 5.4 years, there were 28% with grade 3+ loosening and 36% with progressive implant instability. Implant loosening or progressive instability was not associated with worse pain or PIP joint total arc of motion.
Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. Furthermore, 1 in 4 PIP joint arthroplasties will have grade 3+ radiographic loosening and 1 in 3 will have progressive loosening or subsidence by 5 years. These results are particularly concerning in young patients and those with posttraumatic arthritis. Overall, in patients that do not require revision surgery, pain relief was improved and motion maintained.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在探讨使用热解碳植入物进行近端指间（PIP）关节置换术患者的中期疗效。
本研究分析了99例患者的170例PIP关节热解碳置换术，临床随访至少2年。诊断包括炎性关节炎（n = 49）、创伤后关节炎（n = 29）和骨关节炎（n = 92）。进行了单因素逻辑回归分析和Kaplan-Meier生存分析。
平均随访6年（范围2 - 14年），需要进行58次再次手术（34%），其中36次（21%）涉及植入物翻修手术。大多数翻修手术是由于脱位（n = 16）或疼痛和僵硬（n = 14）。翻修手术的5年和10年无翻修生存率分别为79%和77%。创伤后关节炎患者翻修手术的风险更高。有15例术中并发症涉及骨折，26例术后并发症，包括21例脱位。在未翻修的植入物中，患者术前至术后疼痛水平有显著改善，PIP关节总活动弧无变化。平均影像学随访5.4年时，28%的患者出现3级以上松动，36%的患者出现植入物渐进性不稳定。植入物松动或渐进性不稳定与更严重的疼痛或PIP关节总活动弧无关。
使用热解碳植入物的PIP关节置换术中，约五分之一的患者在5年内需要进行翻修手术，三分之一的患者将接受不止一次手术。此外，四分之一的PIP关节置换术在5年时会出现3级以上影像学松动，三分之一的患者会出现渐进性松动或下沉。这些结果在年轻患者和创伤后关节炎患者中尤其令人担忧。总体而言，在不需要翻修手术的患者中，疼痛缓解得到改善且活动得以维持。
研究类型/证据水平：治疗性IV级。
